Majikthise

Did the fathers of modern obstetrics murder more women than Jack the Ripper?

Latoya Peterson of Jezebel spotted this disconcerting story in Sunday's Guardian:

They are giants of medicine, pioneers of the care that women receive during childbirth and were the founding fathers of obstetrics. The names of William Hunter and William Smellie still inspire respect among today's doctors, more than 250 years since they made their contributions to healthcare. Such were the duo's reputations as outstanding physicians that the clienteles of their private practices included the rich and famous of mid-18th-century London.

But were they also serial killers? New research published in the Journal of the Royal Society of Medicine (JRSM) claims that they were. A detailed historical study accuses the doctors of soliciting the killing of dozens of women, many in the latter stages of pregnancy, to dissect their corpses. [Guardian]

This story has all the makings of an anti-science urban legend. Regardless of the quality of the underlying research, this story is going to get embellished in the retelling and used to bash scientific medicine.

The allegations are already being mentioned in the same breath as documented atrocities like the Tuskegee syphilis study, and Dr. Joseph Mengele's infamous concentration camp experiments.

I checked out Don C. Shelton's original paper. It's a very good read. Shelton raises credible suspicions about where these two doctors got their anatomical specimens. He, shamelessly overstates his case, however. Shelton flatly asserts that Hunter and Smellie were "responsible" for the murders of more women than Jack the Ripper.

The subjects of the anatomy books were women who died in childbirth, or during their final month of pregnancy. Shelton's argument is that there simply weren't enough heavily pregnant and birthing women dying of natural causes in mid-18th-century London to account for all the thirty-plus cadavers that Smellie and Hunter examined to write their respective anatomical classics.

Based on a review of their atlases, Shelton says that the two anatomists came up with a total of 20 cadavers between 1750 and 1754; and that Hunter somehow located another dozen between 1766 and 1774. That works out to four or five such bodies a year for the first stretch and fewer than two a year for the second period.

Shelton concludes that the doctors must have had these women murdered-to-order, a practice known as burking. The term burking is an allusion to the murderers Burke and Hare who smothered their victims in Edinburgh between 1837 and 1838 and delivered them to Dr. Robert Knox, a private anatomy lecturer. 

Shelton acknowledges that there is no research on burking in the mid-18th century.  He doesn't cite any documented cases of burking during that era.

There is no question anatomists of Smellie and Hunter's day got their cadavers from grave robbers. That's how it was done in those dark and superstitious days.

Shelton's case boils down to two rather plausible, but non-dispositive claims: i) very few women died in their 9th month of pregnancy or during childbirth to begin with, and, ii) it's unlikely that ordinary grave robbers would have been able to zero in on these rare cases.

Grave robbers tended to exhume corpses at random, Shelton explains. Or else they targeted the unclaimed bodies of people who died in poorhouses. But he notes that most of those who died in poorhouses were old and sick, not otherwise healthy pregnant women.

Death rates for infectious disease were very high in mid-18th-century London, but Shelton claims that pregnant women would have accounted for small percentage of the death toll. As he points out, they're a subset of the general population and a relatively young and healthy one at that.

Shelton cites statistics to show that the childbed death rate in the mid-18th-century was less than 2%. Based on the birth and death rates and the population of London at the time, he estimates that there would have been about 200 childbed deaths per year.

He argues that women who died in their 9th month of pregnancy would have been rarer still. Shelton suggests that very pregnant cadavers would have been extremely rare because a significant percentage women who suffered lethal illnesses or accidents in their 9th month would have miscarried before they died.

But even at their most productive, the two doctors were only seeing about five of their target subjects a year, on average. Five out of 200 doesn't seem that incredible.

The author also maintains that it would have been very difficult for grave robbers to find these rare specimens: Death notices were rarely published in those days and corpses usually went directly from home to the graveyard without a detour through a funeral home or some other central location that thieves could monitor.

Personally, if I were an 18th-Century anatomist who needed a steady supply of "special" cadavers, I'd start bribing vicars. If you pay for the new church roof, I'm sure it's amazing what you can find out about who's buried where.

So, the paper gives us good reason to doubt that Smellie and Hunter got all their cadavers through the standard grave-robbing channels. But that's hardly proof that the two men commissioned mass murder for hire.

Smellie and Hunter were famous obstetricians. They worked with pregnant and birthing women. In an era where most childbirth was handled at home, they probably served a disproportionately sick patient population.

Let's not forget that primitive obstetrics was really dangerous--no doubt in part because because science was still sketchy on pregnant female anatomy. If anyone was well-situated to tip off grave robbers about dead pregnant women, or take liberties with their corpses, it would have been 18th-century obstetricians.

As the author points out, Smellie and Hunter were rich and well-connected men. He implies that they could have gotten away with murder. On the other hand, if they could have gotten away with murder, they presumably had enough privilege to get what they wanted by less drastic, if socially unacceptable means. 

Shelton claims the following passage, written in 1818, is a smoking gun. The author was describing a plate in Smellie's atlas that features twins:

“Dr MacKenzie being then an assistant to the late Dr Smellie, the procuring and dissecting this woman without Dr Smellie’s knowledge, was the cause of a separation between them, for the leading steps to such a discovery could not be kept a secret."

Smellie died in 1763 and 55 years later, some guy claimed that an associate of Smellie's obtained the corpse by unspecified (but presumably sketchy) means without Smellie's knowledge. This is supposed to be a smoking gun? Really?

Shelton gives us no reason to assume that Smellie and Hunter were monsters. Why immediately jump to the conclusion that they were murderers? There have been killers in the name of science and medicine, but they've always been a tiny minority among scientists and for that matter, a very small subset of murderers. Shelton's wild allegation seems absurd unless you buy into some nasty stereotypes about doctors and scientists.

He makes no attempt to rule out less brutal schemes by which they might have improved their odds relative to common grave-robbers. Could they have performed unauthorized autopsies on pregnant patients who died of natural causes? Bribed the families of the deceased? Stolen the bodies of their own indigent patients? If a body was returned to the family with an incision in the abdomen, the obstetricians could always claim it was a cesarean section.

Were all their subjects even dead? Presumably they could have learned from examining and treating live women. It's a mundane possibility, but who's to say these guys didn't exaggerate the number of corpses they actually looked at? Academic dishonesty is more common than murder.

Obviously, I'm speculating here, but so is Shelton. He makes probabilistic arguments, so I'll make one too: If same end can be achieved through subterfuge or serial murder, most people will opt for subterfuge. Dead pregnant women are rare, but mass murderers are rarer still. Of course, tall tales of body snatchers, natural and supernatural, are as common as dirt.

Shelton is right to question how these doctors got their cadavers, but he simply does not have enough evidence to conclude that these pioneers of modern obstetrics killed more women than Jack the Ripper. This paper is just going to give the science bashers unearned ammunition.

Osama bin Laden's secret weapon to destroy the world: Good advice

Osama bin Laden is speaking out against climate change:

"The effects of global warming have touched every continent. Drought and deserts are spreading, while from the other floods and hurricanes unseen before the previous decades have now become frequent," bin Laden said in the audiotape, aired on the Arab TV network Al-Jazeera.

The terror leader noted Washington's rejection of the Kyoto Protocol aimed at reducing greenhouse gases and painted the United States as in the thrall of major corporations that he said "are the true criminals against the global climate" and are to blame for the global economic crisis, driving "tens of millions into poverty and unemployment."

What a devilishly clever plan to destroy the world.

Bin Laden surely knows that if he rails against climate change, Americans will reflexively champion global warming. Temperatures will soar, decadent Western civilizations will bake and crumble and their parched ruins will be swept away by rising seas. The earth will be scourged by famine, pestilence, war, and plagues too numerous to name. At last, Bin Laden will seize his chance to usher in the medieval Caliphate of his dreams.

Don't let the bearded villain get away with it. Call your member of congress today and demand action on climate change.

UK skeptics plan mass homeopathy "overdose"

Kudos to the UK skeptics planning a mass homeopathy "overdose" to protest the fact that the National Health Service wastes public funds on these quack remedies:

There is still time to sign up for one of the most rational dates of 2010: next week's mass homeopathy overdose. At 10.23am on Saturday 30 January, anti-homeopathy activists, organised by the Merseyside Skeptics Society, will down entire bottles of homeopathic remedies outside branches of Boots, the better to demonstrate that these preparations are worthless.

Even though sales of Hahnemann's potions are likely to be unaffected, there remains a chance that the survival of hundreds of sceptics might persuade officials at Nice, the National Institute for Health and Clinical Excellence, to re-examine the funding of homeopathy within the NHS. It remains one of the world's great mysteries that the health service, with its austere, cash-strapped commitment to evidence-based medicine, should continue to spend an estimated £4m a year on sugar pills. [Guardian]

At least sugar pills contain actual sugar. Homeopathic tinctures are so heavily diluted that they are unlikely to contain any active ingredient whatsoever. It's such an egregious ripoff that I wouldn't even buy a bottle of homeopathic "medicine" in order to chug it. So, next Saturday, I'll homeopathically OD on a glass of New York City tap water. Same difference.

Full body scans, x-rays, and cancer

There's been a lot of talk about full body scans the wake the abortive Christmas Day crotch bombing. Naturally, any of the biggest scanning proponents also sell full body scanners.

A lot of people are nervous about technology that allows TSA screeners to see them naked.

But nobody seems to be asking about the potential health risks of bombarding passengers with x-rays. Not all full body scanners use x-rays, but the TSA has already ordered some that do.

The thing is, X-rays are carcinogenic. That's why your hygienist gives you a lead apron leaves the room when you get dental x-rays.

(Correction: Nevermind about the mammogram example. Thanks to commenters Kittywampus and Butdoctorihatepink for setting me strait.)

No doubt the risks associated with airport screenings are very low, but the relevant question is about the cost/benefit ratio. We shouldn't have to put up with any additional risk unless there's a significant marginal benefit. Even under the status quo, deaths from airplane terrorism are exceedingly rare.

Nate Silver estimates that odds of an air traveler being involved in a terrorist event on any given flight at less than 1 in 10 million. So, if scans caused even a tiny increase in cancer risk among the millions of people who fly every year, the technology could end up killing more people than it saved.

Presumably, it takes a lower dose of x-ray radiation to penetrate clothing than it does to visualize structures deep inside the body. On the other hand, the risks from x-ray exposure are cumulative. Safety guidelines must take into account the risks for frequent fliers. Maybe it's perfectly safe to get scanned once a year, but what if you fly every week? Full-body scans could become an occupational health and safety issue, since so many frequent fliers are traveling for work. 

Maybe scanners are perfectly safe. However, these devices should be subject to the same rigorous safety testing as a medical device. We shouldn't just take the word of the high priced hucksters who are touting them on CNN.

COP15: Obama's high handed pseudo-deal

Barack Obama declared victory and went home. Too bad it was in Copenhagen and not Kabul:

Late on Friday night, President Barack Obama announced that an agreement had been reached, establishing a minimalist accord that would not set a firm schedule with hard-and-fast targets for reducing emissions. But after Obama held a press conference to declare semi-victory—"this is going to be a first step"—and jetted back to Washington, European officials said nothing was in the bag. [Mother Jones]

That evening, Obama sat down with the leaders of four major emerging economies: Brazil, South Africa, India, and China. A Brazilian diplomat who attended the meeting told Kate Sheppard and David Corn of Mother Jones that the major sticking point was international verification of emissions. The U.S. and China had been at odds over verification throughout the summit.

A bit of background: The U.S. won't act on climate change unless China does. China agreed to reduce emissions, but balked at international monitoring. Earlier in the summit, China's foreign minister implied that he was willing to scuttle the talks over verification. Understandably, the U.S. isn't prepared to commit to anything based on China's unverifiable promises. So, the summit was paralyzed for days while the world's two biggest emitters fought over verification.

According to the Brazilian diplomat, Obama floated a new phrase during the eleventh-hour negotiating session: "examination and assessment" of emissions. It was language China could live with. 

Unfortunately, as Sheppard and Corn explain, the draft that came out of the meeting was extremely weak in other ways. The non-binding agreement contains no specific emissions targets and no hard and fast promises of climate aid to developing countries.

The draft sets the goal of somehow raising $100 billion a year for climate aid by 2020. It doesn't say who's going to contribute what, or when. Developing countries know that such vague promises are all but meaningless.

Worse, the draft struck all references to a maximum temperature increase of 1.5 degrees and substituted "less than 2 degrees." This is a life and death distinction for many small island states and low-lying countries. Negotiators wrangled for days over the maximum temperature increase. With a stroke of a pen, Obama's side deal erased hard-won concessions for developing countries.

Obama announced that a deal had been struck and left for D.C.. But it wasn't his deal to strike. The COP in cop15 stands for Council of Parties. By any reasonable standard, a deal at Copenhagen means a deal adopted by the 192-member COP.

COP rules say that any deal has to be adopted by unanimous vote. So, by preemptively declaring victory, Obama basically handed his 12-page document to the world and said "Here, sign this."

As Sheppard and Corn explain, the last-minute meeting was an end run around Europe and the developing world:

The Obama agreement was a sly maneuver. The United States sidestepped the official proceedings and found a way to separate major developing nations from poorer ones—while skating past European desires for a more comprehensive and binding agreement. Though European negotiators first declared they were not on board, as the final evening of the summit entered the wee hours, Europe conceded. At a 2:00 a.m. press conference, dour-looking European leaders announced their unhappy support. "This accord is better than no accord, but clearly below our ambition," said European Commission President Jose Manuel Barroso. "We have to be honest."

So, it's hardly surprising that other countries balked when they were asked to vote for the Obama Accord, which they had no say in drafting. Can you imagine a better way to piss off a roomful of negotiators who have been sweating blood for two weeks than by rewriting the whole deal behind closed doors?

In the end, the COP merely "noted" the agreement instead of adopting it.

It's great that the U.S. and China were able to move forward on verification. That's a major diplomatic achievement for Obama. The Obama Accord could even pave the way for a stronger agreement next year.

Yet, by trying to hype a solid side deal as the Copenhagen Accord, Obama reinforced the stereotypes that have stymied climate change negotiations to date. Throughout cop15, developing countries have complained bitterly that the developed world is ignoring them.

By overselling the agreement Obama confirmed suspicions that the accord is just a figleaf to cover a failed summit.

There is a silver lining here. If conservatives hear that Obama pissed off smaller, weaker countries in Copenhagen, they'll want a treaty for sure.

Copenhagen: A death panel for countries like Tuvalu

 The tiny nation of Tuvalu has taken center stage in Copenhagen. 

"I woke up this morning crying, and that's not easy for a grown man to admit," Tuvalu's chief climate negotiator, Ian Fry, told hundreds of delegates in the Bella Center in Copenhagen on Saturday. "The fate of my country rests in your hands," he said, his voice breaking. Global warming is an existential issue for Tuvalu and other small island nations. If global warming goes unchecked, these countries will literally be wiped off the map. For countries like Tuvalu, COP15 is effectively referendum on their continued existence. Will the rest of the world step up, or will it write them off?

Tuvalu and its supporters want a treaty to protect island states. They also seek legally binding emissions targets for all countries geared to stop global warming at 1.5 degrees above pre-industrial temperatures. 

During the aftermath of the Iranian election, supporters sported green twitter icons to show their support for the protesters. In that spirit, I decided to change my twitter icon to an "I heart Tuvalu" button. The picture is from Tuvalu's official Cafe Press store. Join me!

The Skeptical Gawker: "Cleanses", "toning shoes", and cookie diets

Thank you, Hamilton Nolan of Gawker for shattering illusions with science and reason:

You know what else is bullshit, besides juice cleanses? The idea that wearing some ugly Reeboks with a curvy sole will give you an Ass of Steel. Bullshit. Also, cookie diets? Bullshit.

The cleansing craze is a socially acceptable variant of bulimia.* Crash diets are no longer socially acceptable. These days, even the women's magazines that promote crash diets insist they are offering healthy, sustainable 1200 calorie meal plans.

There is so much evidence that starvation diets are ineffective and dangerous that even quacks now claim to reject them. But evidently, people still want permission to subsist on 800 calories a day and use lot of laxatives. Marketers have responded to the demand. 

Canadian climate research unit burglarized

Via Think Progress:

Burglars and hackers have attacked the Canadian Centre for Climate Modelling and Analysis at the University of Victoria in British Columbia, apparently in an attempt to further the “Climategate” intimidation of global warming researchers. The Climategate smear campaign rests on the release of thousands of emails illegally hacked last month from the British Climatic Research Unit (CRU). The National Post reports that the Centre for Climate Modelling, a government institution, is also the victim of repeated criminal attacks: Andrew Weaver, a University of Victoria scientist and key contributor to the Nobel prize-winning work of the Intergovernmental Panel on Climate Change, says there have been a number of attempted breaches in recent months, including two successful break-ins at his campus office in which a dead computer was stolen and papers were rummaged through.

You wonder why some of those hacked CRU emails suggested something of a siege mentality on the part of their authors? Maybe because these scientists are literally under siege.

Scientists talk smack on listervs! News at 11

Real Climate debunks allegations by global warming deniers that stolen emails from a closed climate science listerv reveal some kind of conspiracy. 

Drug policy FAIL: LSD for cluster headaches

Newsweek has an interesting feature on LSD as an experimental therapy for cluster headaches. Cluster headaches are excruciatingly painful and often resistant to existing treatments. Anecdotal reports suggest that LSD can help sufferers.

Unfortunately, US drug laws preclude clinical trials. LSD is a so-called Schedule 1 drug, which means that the Drug Enforcement Agency has decreed a priori that it has no medical application.

The DEA is a law enforcement agency dedicated to drug prohibition. It has neither the expertise nor the inclination to evaluate the medical potential of controlled substances dispassionately. What if the DEA is wrong about the medical value of LSD? We'll never find out because it's illegal to do research on Schedule 1 drugs.

Update: In theory it's possible to apply for waivers to study Schedule 1 drugs, but according to Newsweek, "[t]hese drugs are so restricted by the DEA that researchers at the country's top universities find it almost impossible to get the permission and funding necessary to study the substances in humans." Legal clearance for a large scale clinical trial is inconceivable in the current climate.